Organization
ALTA MIRA RECOVERY PROGRAMS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WESLEY STEPHENSON (VICE PRESIDENT OF FINANCE)
(619) 820-0034
Entity
Organization
Contact information
Practice address
125 BULKLEY AVE, SAUSALITO, CA 94965-2231
(415) 332-1350
Mailing address
7918 EL CAJON BLVD, STE N227, LA MESA, CA 91942
(415) 332-1350
Taxonomy
Speciality
Code
Description
License number
State
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
—
324500000X
Substance Abuse Rehabilitation Facility
Primary
210034CP
CA
Other
Enumeration date
05/04/2011
Last updated
05/24/2023
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